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Biomedical subjects

C Eckmann

Publications and source records attributed to C Eckmann.

At least 19 recordsLinked to original sources
PubMed2006

Electrical impedance tomography: changes in distribution of pulmonary ventilation during laparoscopic surgery in a porcine model.

BACKGROUND: Because of the creation of a pneumoperitoneum, impairment of ventilation is a common side-effect during laparoscopic surgery. Electrical impedance tomography (EIT) is a method with the potential for becoming a tool to quantify these alterations during surgery. We have studied the change of regional ventilation during and after laparoscopic surgery with EIT and compared the diagnostic findings with computed tomography (CT) scans in a porcine study. MATERIALS AND METHODS: After approval by the local animal ethics committee, six pigs were included in the study. Two laparoscopic operations were performed [colon resection (n=3) and fundoplicatio (n=3)]. The EIT measurements (6th parasternal intercostal space) were continuously recorded by an EIT prototype (EIT Evaluation Kit, Dräger Medical, Lübeck, Germany). To verify ventilatory alterations detected by EIT, a CT scan was performed postoperatively. RESULTS: Ventilation with defined tidal volumes was significantly correlated to EIT measurements (r2=0.99). After creation of the pneumoperitoneum, lung compliance typically decreased, which agreed well with an alteration of the distribution of pulmonary ventilation measured by EIT. Elevation of positive end-inspiratory pressure reopened non-aerated lung areas and showed a recovery of the regional ventilation measured by EIT. Additionally, we could detect pulmonary complications by EIT monitoring as verified by CT scans postoperatively. CONCLUSION: EIT monitoring can be used as a continuous non-invasive intraoperative monitor of ventilation to detect regional changes of ventilation and pulmonary complications during laparoscopic surgery. These EIT findings indicate that surgeons and anesthetists may eventually be able to optimize ventilation directly in the operating theatre.

Animals↗
PubMed2004

Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients.

BACKGROUND: It was the aim of this prospective study to evaluate the outcome of laparoscopic surgery for diverticular disease. METHODS: All patients who underwent elective laparoscopic colectomy for diverticular disease within a 10-year period were prospectively entered into a PC database registry. Indications for laparoscopic surgery were acute complicated diverticulitis (Hinchey stages I and IIa), chronically recurrent diverticulitis, sigmoid stenosis or outlet obstruction caused by chronic diverticulitis. Surgical procedures (sigmoid and anterior resection, left colectomy and resection rectopexy) included intracorporeal dissection and colorectal anastomosis. Parameters studied included age, gender, stage of disease, procedure, duration of surgery, intraoperative technical variables, transfusion requirements, conversion rate, total complication rate including major (requiring re-operation), minor (conservative treatment) and late-onset (post-discharge) complication rates, stay on ICU, hospitalisation, mortality, and recurrence. For objective evaluation, only laparoscopically completed procedures were analysed. Comparative outcome analysis was performed with respect to stage of disease and experience. RESULTS: A total of 396 patients underwent laparoscopic colectomy. Conversion rate was 6.8% ( n=27), so that laparoscopic completion rate was 93.2% ( n=369). Most common reasons for conversion were directly related to the inflammatory process, abscess or fistulas. The most common procedure was sigmoid resection ( n=279), followed by anterior resection ( n=36) and left colectomy ( n=29). Total complication rate was 18.4% ( n=68). Major complication rate was 7.6% ( n=28), whereas the most common complication requiring re-operation was haemorrhage in 3.3% ( n=12). Anastomotic leakage occurred in 1.6% ( n=6). Minor complications were noted in 10.7% ( n=40), late-onset complications occurred in 2.7% ( n=10). Mortality was 0.5% ( n=2). Mean duration of surgery was 193 (range 75-400) min, return to normal diet was completed after 6.8 (range 3-19) days. Mean hospital stay was 11.8 (range 4-71) days. No recurrence of diverticulitis occurred. CONCLUSION: Laparoscopic surgery for diverticular disease is safe, feasible and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution.

Adult↗
PubMed2003

Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach.

BACKGROUND AND AIMS: This study analyzed the results of a standardized approach in anastomotic leakage following low anterior resection for rectal cancer without performance of a protective ileostomy during the primary operation. PATIENTS AND METHODS: The study included all 306 patients with rectal cancer electively undergoing low anterior resection with retroperitonealization of the anastomosis over 9 years. The diagnostic procedure for anastomotic leakage included serum laboratory investigations and abdominal CT together with contrast enema. Minor leakages, i.e., small leakages and pelvic abscess, were treated with rectoscopic lavage and/or CT-guided drainage of the abscess, respectively. Major leakage was defined as broad insufficiency with or without septicemia. Nonseptic patients were treated by ileostomy and rectoscopic treatment. In septic patients a revision of the anastomosis with loop ileostomy was performed. RESULTS: Anastomotic leakage was diagnosed in 30 patients (overall 9.8%; 12 major, 18 minor leakages). Common clinical signs were pelvic pain and fever. No patient developed a peritonitis. The most accurate diagnostic instrument was CT (96.7%). CONCLUSION: Retroperitonealization appears to prevent peritonitis in patients with anastomotic leakage following low anterior resection. A differential treatment leads to good results in terms of mortality and anorectal function.

Adenocarcinoma↗
PubMed2002

[Diagnosis and treatment of streptococcal myositis].

HISTORY AND CLINICAL FINDINGS: Case 1: Following an influenza a 40-year-old patient was treated by intramuscular injections for backache. 24 hours later he was admitted to a hospital with massive pain in both lower extremities and a markedly reduced general condition. Case 2: Two days after a knee joint arthroscopy a 57-year-old man developed strong pain in the extremity treated by application of diclofenac. On the following day the patient was admitted to a university hospital in a septic state with a swollen, cold and blurry changed extremity. INVESTIGATIONS: The myoglobin concentration was dramatically increased in both cases (> 15 000 mg/l). CRP values were elevated. The progressive septic state with acute renal failure was verified by elevation of creatinine concentration and decrease of leukocyte values in the second case (from 10/nl to 2,5/nl) shortly after admission. DIAGNOSIS, TREATMENT AND COURSE: Both the patients died for septic shock. Case 1 died shortly after admission before surgical intervention. The second patient developed rapid progression of the myositis including the trunk despite radical surgical treatment (hip joint exarticulation). CONCLUSION: In cases of sudden and painful swelling of an extremity of unknown origin or following intramuscular injection streptococcal myositis has to be taken into account. Only an immediate surgical intervention up to amputation of the affected extremity can stop the fatal course.

Acute Kidney Injury↗
PubMed2002

[Anticoagulation in the treatment of sepsis. Correction of microcirculation: a new approach manipulating endothelial cell function].

The correction of coagulation disorders is only one aspect in the treatment of severe sepsis. The metabolic changes caused by sepsis are complex. They include the interactions of hundreds of plasma proteins. The system works in balanced patterns of agonists and antagonists, not allowing a preference for single substances. The endothelial cell plays a key role in multiple defence functions in sepsis. Thus, future research in sepsis has to focus on the manipulation of endothelial cell function.

Animals↗
PubMed1999

[Surgical management of peritonitis and sepsis].

The intraabdominal sepsis is one of the major surgical problems today. The Systemic Inflammatory Response Syndrome in peritonitis often leads to multiple organ failure. The surgical eradication of the infectious focus is the most important prerequisite for a successful treatment. Dependent on the form and severity of the local inflammation, different forms of abdominal lavage can be applied. Using surgical and physiological as well as organ failure scores like the Mannheimer-Peritonitis-Index (MPI), the APACHE-II and the Septic-Severity-Score (SSS), the prognosis can be objectively assessed and different clinical studies can be compared. However, in 88 own patients suffering from diffuse purulent peritonitis with sepsis (May 1990 to December 1996), all the above mentioned scores significantly allowed to discriminate surviving (mean MPI: 25, APACHE-II day 1: 19, SSS day 1: 28) from non surviving patients (mean MPI: 31, APACHE-II day 1: 26, SSS day 1: 45). Furthermore, mortality increased significantly with increasing score ranges (< 20, 20 to 30, and > 30 points) for MPI from 0% to 28% to 81%, for APACHE-II day 1 from 20% to 46% to 100%, and for SSS day 1 from 10% to 37% to 71%.

Humans↗
PubMed1998

["Streptococcal toxic shock-like syndrome"].

Since the mid-1980s increasing numbers of severe group A streptococcal infections (Streptococcus pyogenes) have been reported worldwide. Younger, healthy patients after minor local trauma are most commonly afflicted. The infection is characterized by a rapid course with shock, sepsis, multiorgan failure, soft-tissue infection and a high mortality rate. This special disease has been termed "streptococcal toxic shock-like syndrome". The M-proteins, especially types 1 and 3, and the streptococcal pyrogenic exotoxin A (speA) might play an important role in the pathogenesis of the infection. High dose therapy with antibiotics, monitoring in the intensive care unit and early, aggressive and often multiple debridement of necrotic soft tissue are necessary to save the patient's life.

Adult↗
PubMed1997

[Clostridium myonecrosis as a sequelae of intramuscular injections--description of 3 fatal outcomes].

In three fatal cases of clostridial myonecrosis, the following criteria were found: repeated intramuscular injections over several years with anti-inflammatory substances, delay in diagnosis in outpatient care, and following uncontrollable systemic septic complications, despite radical surgical treatment. Only early, aggressive surgical interventions can stop the rapid course of necrotizing soft-tissue infections.

Adult↗
PubMed1997

[Quality assurance in surgical education].

UNLABELLED: The authors determine the reliability, validity and usefulness of the "QuaSi"-test, a test for the evaluation of surgical residents. METHODS: A test with multiple-choice (MC) answers was given to 47 surgeons, residents and interns of our surgery clinic. The reliability and validity of the tests were determined using statistical methods. RESULTS: The reliability of the test was very high. Performance varied significantly according to the level of training (postgraduate year). Surgeons performed best, then the senior residents; students and interns performed worst. CONCLUSION: The QuaSi-test is a highly reliable and valid examination that provides unique information about the performance of individual residents and the quality of postgraduate-training programs.

Clinical Competence↗
PubMed1997

[Laparoscopic staged lavage in CAPD catheter peritonitis--an alternative to open treatment?].

Three patients suffering from severe CAPD peritonitis underwent laparoscopically programmed lavage after removal of the catheter. After an average of four laparoscopic lavage operations all patients had to be treated using conventional open procedures; a mean of ten programmed lavage procedures were carried out because of increasing peritoneal inflammation and worsening of the clinical situation during minimal invasive therapy. One patient did not survive. Laparoscopic treatment is thus not recommended for diffuse peritonitis.

Adult↗
PubMed1996

[Standardized treatment of necrotizing fasciitis].

From the file online at the department of surgery of the Medical University Lübeck, 894 patients with soft tissue infections treated between 0.1 05. 90 and 31. 12. 94 were evaluated. 21 cases (10 men, 11 women) were classified as necrotizing fasciitis (i.e. 2.2%). The mean age was 59.7 years (range 17-84 years). Frequent predisposing diseases were diabetes mellitus (n = 12) and lower extremity ischemia (n = 8) and alcoholism (n = 4). The causing injuries were of minor nature (n = 11), crural ulcers (n = 4) and abscesses caused by intramuscular injection (n = 3). In 7 cases Streptococcus pyogenes group A was responsible for the infection. Different pathogen germs were found in 14 patients. The first essential steps to treat the patient are aggressive surgical debridement and programmed daily revisions. 76 debridements were performed (3.6 per patient). Amputations were necessary in 4 cases. Intensive care treatment and the administration of antibiotics support this surgical therapy. Meshgraft transplantation (n = 18) and secondary suture (n = 11) were done when wound conditions were suitable for it. 4 patients died (19%). An increased mortality was found in patients older than 65 years (36.4%) and if operative treatment was performed more than 5 days from the beginning of symptoms (33.3%). An early diagnosis and standardized treatment lead to better results in terms of mortality and preservation of the infected limb and its function.

Adolescent↗
PubMed1995

[Carcinoma of the gastric stump. Diagnosis, surgical procedure and prognosis].

The results of a retrospective analysis of cases of gastric stump cancer are reported. Among 298 gastric carcinomas treated between 1. 1. 1986 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. Gastric carcinoma showed a male preponderance, with a male:female ratio of ca. 4:1. Two thirds of the patients were older than 70 years at the time of diagnosis. In 27 of 28 patients the original operation performed was a Billroth II resection without Braun's enteroanastomosis. The mean time lag before the development of gastric stump cancer was significantly shorter in the group of patients older than 45 years at the time of first operation (n = 16) than in patients 45 years or younger (n = 12, P = 0.03). Endoscopy with biopsy and endosonography were highly reliable diagnostic instruments. The capability of CT for recognizing lymphatic metastasis is poor (42.1% sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, are male sex, Billroth II resection for first reconstruction, age over 45 years at first operation, and gastric ulcer as reason for the original gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.

Adult↗